Chapter 28

One of the hardest things for Sarah about the ICU was seeing people her own age or even younger, people who never in their short lives imagined they could get sick, now fighting to live. Meningitis, brain aneurysms, carbon monoxide poisoning from a faulty heater—these were problems any unlucky person could get. Some people went home. Some people did not. When the patients were young, it was easy for Sarah to imagine herself or her brother or her friends in the same situation. It made it hard to be objective, which was an important part of medicine. But maybe not the most important part.

One of Sarah’s patients was a newlywed who mixed ammonia and bleach while cleaning the bathroom to surprise his new bride, who arrived home to find him unconscious and barely breathing. She had to do mouth-to-mouth herself until the ambulance came, and he was in full arrest when he arrived at the hospital. He had been on a ventilator for weeks now, and neurology tests showed he had suffered severe brain injury from not enough blood flow. He had never regained consciousness. There was little hope he would recover. Despite multiple conversations with Sarah and the attending physician, his wife and his parents couldn’t bring themselves to make the decision to turn off the ventilator, couldn’t even decide to make him “DNR” or “Do Not Resuscitate.” If he died, if his heart stopped, the doctors would be obligated to bring him back to life. To the life of the machines.

His family was frozen.

Sarah sat with them every day. She held his mother’s hand. She brought his father coffee.

Sarah was almost done with her ICU rotation. She would turn this man and his family over to the next team. She was alone with his wife at his bedside, maybe for the last time. Sarah brushed away a lock of the man’s hair that was caught under the tubing on his face. He was so young. His wife was so young.

The man’s kidneys had shut down, and he couldn’t get rid of his fluids. His face was swollen, and the tubing left an imprint as Sarah shifted it. His wedding band was long gone, removed before his fingers turned into sausages. The skin on his edematous arms was pale and stretched and weepy in some areas. He had catheters and tubes and patches and lines everywhere.

“His bachelor apartment was such a mess.” His wife said this out of the blue. Sarah smiled at her from across the bed.

“He always said we were meant to be together, and I’d joke that the state of his bathroom was keeping us apart. I never liked staying at his place.”

For the umpteenth time, Sarah studied the photo pinned to the bulletin board of the young couple. Their heads were tossed back, laughing, and their arms were linked. Sarah imagined them together, carefree.

The woman touched her husband’s swollen hand lightly with her fingertips. “He proposed to me with a diamond ring and a toilet brush. He said the ring was for me and the brush was for him. Our bathroom would never come between us.” She bent and brushed her lips on his cheek.

Sarah busied herself adjusting a ventilator setting.

“He promised to make our bathroom sparkle because I was the sparkle in his life. That’s what he said. That’s how he is.”

Sarah’s hand dropped. Her eyes smarted. She tried hard, but she couldn’t help herself. She’d been up most of the night with her last call night of the ICU. The fatigue and the stress magnified every emotion. She started to cry, thankful her back was turned. An alarm sounded and she spun back to him, but it was just the IV.

His wife stared at Sarah and her tears. The young woman’s lips pressed together and her face turned red. She took a few short breaths, then let out a soft howl as tears flowed down her cheeks. Sarah hurried around the bed and put her arm around her shoulder. They leaned into each other and sobbed. Then the room was silent except for the ventilator as they stood side by side.

The cardiac monitor broke the silence. Sarah’s head flew up and she read the rhythm on the monitor. V-fib. He was coding. The harsh alarm brought the nurses into the room pushing the code cart. The respiratory tech ran in behind them.

“He’s in V-fib.” Sarah pointed to the first nurse into the room. “Lianne, start chest compressions.”

Sarah tore open the defibrillator pads and placed them on the man’s chest. She cranked the knob on the defibrillator. She turned her head back and nodded at the man’s wife. “You should wait outside. I’ll come as soon as I can.”

“Everybody clear!” Sarah shouted, making sure the team stepped away from the bed. She hit the button and the pads delivered the shock. The man’s body jumped.

“Resume CPR,” Sarah said, and Lianne started compressions again.

“Two minutes, doctor,”

“Hold CPR.” The monitor showed a sinus rhythm. Sarah checked his pulse. She felt it, faint but growing stronger. The code was over. The man had been brought back to life.

As the nurse checked his blood pressure, footsteps rushed into the room. Sarah’s ICU attending stopped short of the bed, glancing from the monitor to Sarah. “Excellent work, Dr. James. I see I’m not needed here at all.”

Sarah smiled despite the sad surroundings. “If it’s all right with you, I’d like to let his wife know.”

“Of course. Yes. I’ll finish here.”

Sarah found his wife just outside the door, crying. Sarah reached out and touched her arm. “He came through,” Sarah said. The woman cried harder.

The team filed out of the room. Sarah’s attending nodded at the man’s wife. “You can go back in now.”

“Come with me?” The woman pulled Sarah back in. They stood again next to the bed. The man looked exactly the same, as if the code had not happened.

His wife whispered, “In the hall, I wished you couldn’t save him. Then it would be over. Then I wouldn’t have to make the choice. But I know what the right choice is. You’ve been telling me all along. I can see how much you care about him. So I know this decision is best.”

She waved her hand over the bed. “This not my husband, my darling, the man who lived for me and me for him. I know he’s not here.”

Sarah couldn’t get any words out. Her throat was tight, her eyes full of tears.

His wife knelt down next to the bed. “I love you, my sweet.” She turned her face up to Sarah. “It’s time,” she said.

So on the last day of her ICU rotation, after the man coded and they brought him back to life, they turned off the ventilator. Sarah dug her fingernails into the palms of her hands to keep from becoming a bawling mess. She barely held herself together. All the emotion, all the sleepless nights, all the highs and lows of the month in the ICU culminated in this family’s story.

She hugged the man’s wife, his parents. She left them in the room to say their final good-byes.

Her attending waited outside the door. “Tough case,” he said.

Sarah could only nod.

He leaned against the nurses’ desk, arms crossed. “The only reason they changed their mind was you. You helped them find their way. You got emotionally involved, you let yourself be vulnerable. Yet you could still conduct yourself calmly during the code. Strong work.” He pushed himself up and walked down the hall.

Sarah had hoped to go forward as a doctor with objectivity and without emotion. It was impossible. She couldn’t change who she was. Not yet, anyway. She was a resident, and residency was three years. She’d get better at this. But today she was happy to be where she was.